Table 2

Systematic reviews of homoeopathy with a more specific focus

AuthorResultsAuthors' conclusions and reviewer's notesQuality assessment*
*Assessment of methodological quality: 1=selection criteria, 2=search strategy, 3=validity assessment of primary studies, 4=presentation of details of primary studies, 5=data synthesis.
RCT=randomised controlled trial; OR=odds ratio; RR=relative risk; OA=osteoarthritis; NSAID=non-steroidal anti-inflammatory drug.
Ernst24 (Arnica)8 controlled clinical trials met inclusion criteria (n=338) (1966–97). Potencies of arnica differed across the trials. Two trials showed a statistically significant result in favour of arnica (1 delayed onset muscle soreness and 1 prevention of postoperative complications). The remaining six trials did not demonstrate statistically significant between group differences. Most of the trials had methodological problems and the higher quality studies tended to have negative findings.Authors' conclusions: the claim that homoeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials. Reviewer's notes: more information on individual study details would have been welcome, particularly relating to results in terms of actual numbers and p values. Two of the included studies were of experimentally induced trauma; possible problems of generalisation to usual clinical practice. There is some overlap with two of the more general reviews.7,131=fair 2=fair 3=good 4=fair 5=fair
Barnes23 (postoperative ileus)6 controlled clinical trials met inclusion criteria (n=1076) (?–1996). The pooled weighted mean difference (n=6) showed a reduction in the delay in restoration of intestinal peristalsis, as measured by time to first flatus, with homoeopathic treatment compared with placebo (–7.4 hours, 95% CI –4.0 to –10.8 hours, p<0.05). Sensitivity analysis of higher quality trials (n=4): WMD –6.11 hours (95% CI –2.31 to –9.91 hours, p<0.05). The largest and most rigorous study showed no statistically significant differences between groups.Authors' conclusions: homoeopathic treatment administered immediately after abdominal surgery may reduce the time to first flatus compared with placebo. Analyses do not provide evidence for the use of a particular homoeopathic remedy or for a combination of remedies for postoperative ileus. Several drawbacks inherent in primary studies and in the methodology of meta-analysis preclude a firm conclusion. Reviewer's notes: overlap with some of the more general reviews.7,13,14 More details on participants (age and surgery type) would have been useful. Test for heterogeneity not reported.1=fair 2=fair 3=fair 4=fair 5=fair
Ernst27 (delayed onset muscle soreness; DOMS)8 trials met inclusion criteria (3 randomised) (n=311) (1966–97). There was a high level of heterogeneity between included studies with regard to the type of homoeopathic remedy used and the type of exercise used to induce DOMS. 3 RCTs all reported non-significant differences between groups for all outcome measures. Results from the non-randomised studies were inconsistent. The three RCTs were rated as being of higher methodological quality than the other studies.Authors' conclusions: the published evidence does not support the hypothesis that homoeopathic remedies are more effective than placebo in alleviating the symptoms of DOMS. Reviewer's notes: there is some overlap with the more general reviews.7,13 Since few details of the primary studies are presented, it is difficult to determine whether the authors' conclusions follow from the evidence.1=fair 2=fair 3=fair 4=poor 5=fair
Jonas28 (rheumatic disease)Six RCTs met inclusion criteria (n=392) (1966–95). Three RCTs on RA were included (n=226) and one each on OA (n=36), fibromyalgia (n=30), and myalgia (n=60). The pooled OR (6 RCTs) was 2.19 (95% CI 1.55 to 3.11). Pooled OR for five high quality trials was 2.11 (95% CI 1.32 to 3.35).Authors' conclusions: all studies were statistically but not clinically homogenous with regard to patient selection, treatment strategies, and outcomes. Reviewer'notes: this review is a subset of a larger review.13 Some of this summary and assessment has been based on information provided in the larger review. This paper provided few details of the individual trials, and the outcome measurements used were not mentioned. Since clinically heterogeneous data have been pooled, the results should be interpreted with great caution.1=fair 2=good 3=good 4=fair 5=poor
Long29 (OA)Four RCTs met inclusion criteria (n=406) (up to 2000). All RCTs were judged as being of high methodological quality, but none were free of flaws. All recruited people with knee OA and assessed improvement in pain (duration range 2–5 weeks). One RCT found a statistically significant difference in favour of a homoeopathic gel compared with an NSAID gel. Another RCT, which also recruited people with hip OA, showed a statistically significant difference in favour of fenoprofen when compared with homoeopathy or placebo, with no difference observed between homoeopathy and placebo. The other two trials did not show any statistically significant differences between homoeopathy and control.Authors' conclusions: the small number of RCTs conducted to date preclude firm conclusions as to the effectiveness of combination homoeopathic remedies for OA. The standardised treatments used in the trials are unlikely to represent common homoeopathic practice where treatment tends to be individualised. Reviewer' notes: the results of the review also preclude firm conclusions, as findings were inconsistent across trials.1=fair 2=good 3=fair 4=fair 5=fair
Ernst21 (headaches and migraine)4 double blind RCTs met inclusion criteria (n=284) (1966–98). 1 RCT was of poor methodological quality, 2 were intermediate, and 1 good. One RCT found statistically significant improvement in all outcomes in favour of homoeopathy. A second found no significant between-group differences in terms of frequency, intensity, or duration of attacks, nor analgesic consumption, although the neurologist's assessment of attack frequency suggested a statistically significant difference in favour of homoeopathy. Two trials did not find any statistically significant differences between groups.Authors' conclusions: these data do not suggest that homoeopathy is effective in the prophylaxis of migraine or headache beyond a placebo effect. Reviewer's notes: overlap with two of the more general reviews.13,15 The authors' conclusions follow on from the results but should be viewed with caution because of the small number of studies available and limited methodological quality of three out of the four studies.1=fair 2=fair 3=fair 4=fair 5=fair
Linde26 (asthma)3 placebo controlled, double blind RCTs met inclusion criteria (n=154) (1966?–97). RCTs used different homoeopathic treatments which precluded quantitative pooling of results. Treatments in the RCTs were unrepresentative of common homoeopathic practice. In one trial severity of symptoms significantly lessened in the homoeopathy group compared with placebo. In another, lung function measures and medication use showed improvement in the homoeopathy group compared with placebo (this trial was of lowest methodological quality). The third trial found improvement in both groups, but no statistically significant difference between groups.Authors' conclusions: there is not enough evidence to reliably assess the possible role of homoeopathy in asthma. As well as RCTs, there is a need for observational data to document the different methods of homoeopathic prescribing and how patients respond. Reviewer's notes: Cochrane review. Dates for search strategy unclear. There is some overlap with one of the general reviews.131=good 2=fair 3=good 4=fair 5=fair
AuthorResultsAuthors' conclusions and reviewer's notesQuality assessment*
Vickers25 (influenza)7 RCTs met inclusion criteria; three prevention (n=2265) and four treatment (n=1194) (1966–99). Problems with methodological quality and quality of reporting were found with the trials. Prevention: heterogeneity was found between trials (χ2=6.5, p=0.01) for the occurrence of influenza. There was no evidence that homoeopathic treatment can prevent influenza-like syndrome (RR 0.64, 95% CI 0.28 to 1.43). Treatment: oscillococcinum reduced length of influenza illness by 0.26 days (95% CI 0.47 to 0.05) and increased the chance of a patient considering treatment effective (RR 1.08, 95% CI 1.17 to 1.00).Authors' conclusions: oscillococcinum probably reduces the duration of illness in patients presenting with influenza symptoms. Though promising, the data are not strong enough to make a general recommendation to use oscillococcinum for first line treatment of influenza. Current evidence does not support a preventive effect of homoeopathy in influenza. Reviewer's notes: Cochrane review1=good 2=fair 3=good 4=fair 5=fair